Amid speculation about the outcome, The Department of Justice (DOJ), joined by a number of states, filed complaints on July 21 in federal district court challenging the mergers of health insurance giants Anthem and Cigna and Aetna and Humana. Attorney General Loretta Lynch announced the filing and noted that these deals would eliminate competition at […]
Veralon Views Blog
The Veralon Views blog is an extension of our partnership with leaders who are transforming the healthcare industry. Here, we share expert perspectives from our nationally recognized senior consulting team on issues that are key to the success of your organization.
The healthcare industry has less than six months to prepare for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). But according to a recent survey by Deloitte, it may be an uphill battle. According to Deloitte’s 2016 Survey of US Physicians, “half of surveyed physicians have never heard of MACRA, and most […]
Hospitals have been adding services to their outpatient departments in recent years as a means of reducing utilization in costlier inpatient settings as they move to population-based payment models. Medicare’s Outpatient Prospective Payment System (OPPS) proposed rule issued this week might negatively affect this trend, according to finance experts. The proposed rule would disqualify […]
Physician movement and competition for top talent has caused an “upward spike” in physician payment, according to Merritt Hawkins, a healthcare recruitment firm. The firm’s data from April 1, 2015 to March 31, 2016 show a surge in compensation increases among 19 of 20 specialties it tracks. Merritt Hawkins has conducted an annual review […]
Smaller accountable care organization (ACO) officials wrote comments to CMS noting that some provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) could hurt the viability of smaller ACOs. The proposed rule, MACRA, will split physicians into those paid under the Merit-based Incentive Payment System (MIPS) and those paid annual […]
CMS issued a final rule last week that will allow accountable care organizations (ACOs) to benchmark their results to regional Medicare spending, using a phased approach to incorporating regional fee-for-service (FFS) expenditures into calculations for resetting, adjusting, and updating an ACO’s rebased historical benchmark after an initial three-year agreement period. National benchmarks will continue […]
Healthcare system executives are well aware that physician employment agreements must be consistent with Stark and Anti-Kickback legislation requiring that they not pay more than fair market value (FMV) for any services provided or received. However, quantitative benchmarking is only part of the story. As regulatory scrutiny continues to increase, it is imperative that certain […]
CMS will allow primary care practices in the Medicare Shared Savings Program (MSSP) to participate in the Comprehensive Primary Care Plus (CPC+) initiative. The announcement came in response to stakeholder concerns that a new Medicare primary care payment model could steer physicians away from accountable care organizations. Up to 1,500 eligible primary care practices […]
Proactive collaboration allows AMCs and community counterparts to benefit from each other’s strengths, creating value that wasn’t necessarily sought or derived from more traditional partnering approaches. In Part I of this blog post on partnerships between community hospitals/systems and academic/major teaching centers (“AMCs”) we: Explored changes in AMC rationale for pursuing partnerships and partner attributes […]
Note: iProtean, now part of Veralon editorial staff will be on holiday next week, celebrating Memorial Day. Look for the next blog/newsletter June 1. Enjoy the holiday! The uninsured rated dropped from a high of 16.3 percent in 2010, the year the Affordable Care Act was enacted, to 9.1 percent in 2015, according to […]